| NPI | 1477643377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA c50765) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA c 50765) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2013-04-11 |